Michelle Andrews: Sanders is right to assert that millions can’t find a physician
From Kaiser Family Foundation Health News
Sen. Bernie Sanders (I-Vt.) has long been a champion of a government-sponsored “Medicare for All” health program to solve long-standing problems in the United States, where we pay much more for health care than people in other countries but are often sicker and have a shorter average life expectancy.
Still, he realizes his passion project has little chance in today’s political environment. “We are far from a majority in the Senate. We have no Republican support … and I’m not sure that I could get half of the Democrats on that bill,” Sanders said in recent remarks to community health advocates.
He has switched his focus to include, among other things, expanding the primary-care workforce.
Sanders introduced has introduced legislation that would invest $100 billion over five years to expand community health centers and provide training for primary-care doctors, nurses, dentists, and other health professionals.
“Tens of millions of Americans live in communities where they cannot find a doctor while others have to wait months to be seen,” he said when the bill was introduced. He noted that this scenario not only leads to more human suffering and unnecessary deaths “but wastes tens of billions a year” because people who “could not access the primary care they need” often end up in emergency rooms and hospitals.
Is that true? Are there really tens of millions of Americans who can’t find a doctor? We decided to check it out.
Our first stop was the senator’s office to ask for the source of that statement. But no one answered our query.
Primary Care, by the Numbers
So we poked around on our own. For years, academic researchers and policy experts have debated and dissected the issues surrounding the potential scarcity of primary care in the United States. “Primary care desert” and “primary care health professional shortage area” are terms used to evaluate the extent of the problem through data — some of which offers an incomplete impression. Across the board, however, the numbers do suggest that this is an issue for many Americans.
The Association of American Medical Colleges projects a shortage of up to 48,000 primary-care physicians by 2034, depending on variables like retirements and the number of new physicians entering the workforce.
How does that translate to people’s ability to find a doctor? The federal government’s Health Resources and Services Administration publishes widely referenced data that compares the number of primary care physicians in an area to its population. For primary care, if the population-to-provider ratio is generally at least 3,500 to 1, it’s considered a “health-professional shortage area.”
Based on that measure, 100 million people in the United States live in a geographic area, are part of a targeted population, or are served by a health care facility where there is a shortage of primary-care providers. If they all want doctors and cannot find them, that figure would be well within Sanders’ “tens of millions” claim.
The metric is a meaningful way to measure the impact of primary care, experts said. In those areas, “you see life expectancies of up to a year less than in other areas,” said Russ Phillips, a physician who is director of Harvard Medical School’s Center for Primary Care. “The differences are critically important.”
Another way to think about primary-care shortages is to evaluate the extent to which people report having a usual source of care, meaning a clinic or doctor’s office where they would go if they were sick or needed health-care advice. By that measure, 27 percent of adults said they do not have such a location or person to rely on or that they used the emergency room for that purpose in 2020, according to a primary-care score card published by the Milbank Memorial Fund and the Physicians Foundation, which publish research on health care providers and the health care system.
The figure was notably lower in 2010 at nearly 24 percent, said Christopher Koller, president of the Milbank Memorial Fund. “And it’s happening when insurance is increasing, at the time of the Affordable Care Act.”
The U.S. had an adult population of roughly 258 million in 2020. Twenty-seven percent of 258 million reveals that about 70 million adults didn’t have a usual source of care that year, a figure well within Sanders’ estimate.
Does Everyone Want This Relationship?
Still, it doesn’t necessarily follow that all those people want or need a primary-care provider, some experts say.
“Men in their 20s, if they get their weight and blood pressure checked and get screened for sexually transmitted infections and behavioral risk factors, they don’t need to see a regular clinician unless things arise,” said Mark Fendrick, an internal-medicine physician who is director of the University of Michigan Center for Value-Based Insurance Design.
Not everyone agrees that young men don’t need a usual source of care. But removing men in their 20s from the tally reduces the number by about 23 million people. That leaves 47 million without a usual source of care, still within Sanders’ sbroad “tens of millions” claim.
In his comments, Sanders refers specifically to Americans being unable to find a doctor, but many people see other types of medical professionals for primary care, such as nurse practitioners and physician assistants.
Seventy percent of nurse practitioners focus on primary care, for example, according to the American Association of Nurse Practitioners. To the extent that these types of health professionals absorb some of the demand for primary-care physician services, there will be fewer people who can’t find a primary-care provider, and that may put a dent in Sanders’ figures.
Finally, there’s the question of wait times. Sanders asserts that people must wait months before they can get an appointment. A survey by physician-staffing company Merritt Hawkins found that it took an average of 20.6 days to get an appointment for a physical with a family physician in 2022. But that figure was 30 percent lower than the 29.3-day wait in 2017. Geography can make a big difference, however. In 2022, people waited an average of 44 days in Portland, Ore., compared with eight days in Washington, D.C.
Our Ruling
Sanders’s assertion that there are “tens of millions” of people who live in communities where they can’t find a doctor aligns with the published data we reviewed. The federal government estimates that 100 million people live in areas where there is a shortage of primary care providers. Another study found that some 70 million adults reported they don’t have a usual source of care or use the emergency department when they need medical care.
At the same time, several factors can affect people’s primary-care experience. Some may not want or need to have a primary-care physician; others may be seen by non-physician primary care providers.
Finally, on the question of wait times, the available data does not support Sanders’s claim that people must wait for months to be seen by a primary care provider. There was wide variation depending on where people lived, however.
Overall, Sanders accurately described the difficulty that tens of millions of people likely face in finding a primary-care doctor.
We rate it Mostly True.
Michelle Andrews is a reporter for KFF Health News.